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Aetna GR-68744-3 2019 free printable template

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For Medicare Advantage Part B: PHONE: 18665030857 FAX: 18442687263MEDICARE FORM Viscosupplementation Injectable Medication Recertification Requestor other lines of business: Please use other form.
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People Also Ask about

Steroids are not covered for the enhancement of performance, as this is not considered treatment of disease.
Viscosupplementation of joints other than the knee(s) will be considered not reasonable and necessary and will not be subject to coverage. Imaging procedures performed routinely for the purpose of visualization of the knee to provide guidance for needle placement will not be covered.
Yes, Aetna's CPB for this states that ultrasound-guided injection is not covered since they consider it experimental.
Aetna considers intra-articular glucocorticoid injections medically necessary for the treatment of knee OA.
“We SUGGEST viscosupplementation injections for knee OA for those under the age of 60 years based on MODERATE quality evidence due to response of treatment in those over 60 years of age.”

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Aetna GR-68744-3 is a specific insurance plan document that outlines the coverage options and benefits provided by Aetna for eligible members.
Individuals who are covered under the Aetna GR-68744-3 plan, typically employees of companies that provide this plan as part of their benefits package, are required to file.
To fill out Aetna GR-68744-3, members need to provide personal information, insurance details, and any relevant medical information as required in the form.
The purpose of Aetna GR-68744-3 is to document the insurance coverage provided to members and ensure they understand their benefits and the claims process.
Information that must be reported includes member identification details, plan selection, coverage dates, and any claims or services rendered under the policy.
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